Is An Episiotomy Necessary With A Shoulder Dystocia

American Journal of Obstetrics and Gynecology, 04/25/2011

Paris AE et al. – Despite historical recommendations for an episiotomy to prevent brachial plexus injury when a shoulder dystocia is encountered, the trend authors observed does not suggest benefit from this practice.

Methods

All births at Brigham and Women’s Hospital from September 1, 1998 through August 31, 2009 were reviewed.

Total number of births, mode of delivery, shoulder dystocias, episiotomies with and without shoulder dystocias, and brachial plexus injuries were recorded.

A non-parametric test of trend was performed.

There were a total of 94,842 births, 953 shoulder dystocias and 102 brachial plexus injuries.

Results

The rate of episiotomy with shoulder dystocia dropped from 40% in 1999 to 4% in 2009 (p=0.005) with no change in the rate of brachial plexus injuries per 1000 vaginal births.